A federal task force is recommending increased screening and treatment for postpartum depression, a serious illness that puts one in seven new mothers and their infants at risk. Getting these women appropriate help and support is critical. Sometimes that means therapy – but not always.
There is a strong association between maternal depression and not being able to afford a basic material need — diapers, a Yale study done in cooperation with the National Diaper Bank Network showed. Moms in our study ranked diaper need as more stressful than food insecurity.
Far too often we conflate poverty with mental illness. Advances in brain science teach us that people living in poverty are frequently depressed and anxious. Depression and anxiety are rational responses to their circumstances. You cannot medicate or counsel someone struggling to clean and clothe her child into a sense of well-being, but you can help, probably more quickly and cheaply than through the traditional clinical intervention. Any mother screened for post-partum depression should be asked about basic needs and if necessary given help to obtain them.
The postpartum depression statement from the U.S. Preventive Services Task Force coincided with the release of a study from the Urban Institute showing that 40 percent of Americans struggle to meet basic needs, like food, housing and utilities. That signals widespread stress that will wreak havoc on the physical and mental health of the population. This is a public health emergency. As is so often the case in a public health emergency, the solution lies more in providing basic resources than clinical services.
Those of us in health care and social work are trained on a disease model. A baby comes to our offices in clothes that smell ripe. Our training kicks in and we look for a disease to blame. Is the laundry not getting done because Mom is depressed or using drugs? Is there a failure to form a healthy parent-child bond? If the answer is “yes,” we have access to a variety of interventions
But what if Mom simply cannot afford detergent or does not have access to a washing machine? Few providers think to ask, and parents who are embarrassed or afraid of the scrutiny of a child welfare agency will not volunteer the information. For those providers who do have a conversation about basic needs, the options are few. You can’t bill insurance for a trip to the laundromat.
Together with colleagues at Yale, I developed a Basic Needs-Informed Curriculum that we’ve been teaching to clinicians, human services professionals and educators. We ask these professionals to start talking with the individuals they serve about the concrete realities of their lives and asking simple questions, such as, “Do you have toilet paper?”
One psychiatrist said after the training: “I’ve been using Prozac to treat poverty, and it hasn’t worked.”
That kind of humility is the first step toward delivering basic needs-informed care and must guide how we address postpartum depression, especially considering the profound risk to mothers and to their children’s health, development and future.
All professionals who serve people in poverty should be trained to recognize when resources are affecting behavior, rather than automatically pathologize patients or, even worse, impugn their character. The person who is late for appointments may not be able to afford reliable childcare or transportation, but he is often pegged as unmotivated or inconsiderate. If our first response is a lecture, we cannot build sufficient trust to uncover the behavior’s root.
Clinical programs must have access to resources that address material needs driving poor health. Research shows that one in three U.S. families experiences diaper need. As the Urban Institute study demonstrated, nearly half the population has difficulty with at least one basic need. So this recommendation to become basic needs-informed is not just for the street outreach clinic – it is for every setting, serving every population.
Finally, those of us in the helping professions need to talk honestly with clients about the struggles they face; and we need to let payers and policymakers know that the people we serve do not need to change – the system under which we live does. This conversation is difficult, complex and urgent.
Rising health care costs and rising inequality each pose serious threats to the nation’s economic health. They should not been seen in isolation. Common sense and research both tell us that meeting a family’s basic needs establishes the foundation for children and their families to realize their full potential.
Joanne S. Goldblum is CEO of the National Diaper Bank Network in New Haven.